On June 23, 2010, the Centers for Medicare & Medicaid Services (CMS) announced plans to release the third installment of its CROWNWeb data-collection system to the end-stage renal disease (ESRD) community. Set for January 2011, Phase III will include at least 360 dialysis facilities throughout the nation—a mixture of both independent and large dialysis organizations (LDOs). This release will allow twice as many facilities as in Phase II to report their patients’ data to CMS via CROWNWeb.

Similar to the first two installments, Phase III will include many enhancements and modifications that are based on user feedback and federal computer system regulations. These changes will range from updates to the graphical user interface (GUI) to providing users a warning that they will be logged out of the system for inactivity five minutes prior to their session ending. Additionally, Phase III will introduce two new elements that are intended to further secure the sensitive data available via CROWNWeb. These new components are known as the QualityNet Identity Management System (QIMS) and CROWNWeb multi-factor authentication.

CROWNWeb Overview

CROWNWeb is a Web-based data-collection system that allows authorized users to securely submit and access patientbased data (both clinical and non-clinical) from virtually anywhere at any time. It is the tool designed by CMS to enable facilities to comply with Section 494.180(h) of the updated ESRD Conditions for Coverage (published on April 15, 2008), which outlines the electronic submission of administrative and clinical data by all Medicare-certified dialysis facilities in the United States—a move away from the current paper-based data-collection methods. CMS is leveraging CROWNWeb to streamline how the renal community will both report and access facility and patient data.

CMS released CROWNWeb in phases in order to analyze how users would interact with the system, and to give future users an opportunity to complete the required account activation process (to be discussed later in this article). Since CROWNWeb’s initial release in February 2009, CMS has been able to review and analyze electronically submitted data for more than 280,587 dialysis patients, which represents more than 74 percent of the total ESRD population in the United States.

CROWNWeb Phase III System Changes

Each phase of CROWNWeb has pioneered new enhancements and modifications that simplify users’ interaction with the system. Phase III users will notice many modifications to CROWNWeb’s GUI. These changes will help to ensure that the system continues to meet federal accessibility standards, as well as address the needs expressed by users. Some of the key changes to the system that are anticipated for Phase III include:

• My Reports Repository: Users will still be able to run reports in CROWNWeb by navigating to the Reports screen, clicking the link for the desired report, and entering the information needed to run that report. Phase III will give users the ability to retrieve the data at a later time. Reports will be available on a new My Reports page approximately two to five minutes after a request is submitted, and will be accessible and downloadable from the My Reports page for seven days.

• Timeout Warning: CROWNWeb currently has a built-in timeout clock that automatically logs users off if their accounts have been inactive for more than 15 minutes. This security feature helps to prevent unauthorized access to patient data from an unattended computer terminal. Prior to CROWNWeb’s initial launch, users expressed the need for a mechanism that would alert them when CROWNWeb was close to terminating their session. As a result of this feedback, Phase III is slated to include a timeout warning feature that will inform users that their session will expire in five minutes. The user will then have the ability to “ignore” the alert or “extend” his/her session an additional 15 minutes.

• Masking of Patient Data: The CROWNWeb system stores hundreds of thousands of personally identifiable and personal healthcare information records. In an effort to prevent the inadvertent disclosure of any sensitive data, the Patient Search Results page in CROWNWeb is being redesigned to conceal portions of patients’ Social Security and Health Insurance Claim Numbers (HIC Numbers). Once a user selects an individual patient, the patient’s complete details will display without restrictions.

CROWNWeb’s Security: QIMS and Multi-Factor Authentication

Due to the sensitivity of the data available via CROWNWeb, the system must adhere to information security and acceptable risk safeguard policies mandated by CMS and the National Institute of Standards and Technology. In order to meet these guidelines, Phase III will feature a new process that will strengthen CROWNWeb’s account management requirements.

The QualityNet Identity Management System (QIMS) is an identity management security service (IdM) that will capture the information collected during the registration process and provide each user with an identity credential and access to approved QualityNet applications (which includes CROWNWeb). This new IdM security service replaces the previously used QualityNet Identity Provisioning System (QIPS).

QIMS will address critical areas in which QIPS does not currently meet federal standards for identity, credential, and access management. It will incorporate extra levels of security administration, and will offer services such as digital identity proofing, account privilege management, cryptography, and auditing and reporting. Users needing access to CROWNWeb will need to complete application procedures in QIMS, as they did in QIPS.

However, QIMS will expedite the account activation process by allowing users to submit their applications online; the application will then be automatically routed to the designated End-User Manager for authorization. Additionally, QIMS will now allow the End-User Manager to authorize a user’s request to access CROWNWeb. These changes will eliminate the need for a third-party organization to be involved with creating a new user account; activations will now be managed at the facility level by the End-User Manager and the facility’s Security Official. See Figure 1 for an illustration how an End-User, the End-User Manager, and the Security Official will interact with the QIMS system to create an account.